Manager of Service Operations

The Membership team is a group of dedicated, hard-working, enthusiastic individuals working at the heart of service operations. This team maintains the business function of our mailroom, enrollment and premium billing activities, including ensuring accuracy and timeliness of enrollment applications, maintaining CMS compliance, resolving escalated issues, and ensuring accurate member data throughout the member's journey with Clover. The team also works on projects to improve the efficiency and accuracy of cross-functional activities of Insurance Operations. The success of insurance operations relies on collaboration with our internal counterparts: Claims, Utilization Management, Appeals, Grievances, and Customer Experience.

We are looking to hire a Manager of Service Operations to improve the productivity of Clover's enrollment and mailroom function through strong organizational skills and operational oversight.

In this role you will be responsible for overseeing and maximizing the relationship with our Business Process as a service (BPaas) vendor through managing day-to-day interactions, while also ensuring adherence to SLAs and compliance with Clover's internal policies and procedures.

As a Manager of Service Operations, you will:

• Manage all Enrollment and Billing operations effectively, efficiently and compliantly to ensure that applicant and member information is processed accurately, appropriately and timely.
• Ensure members are billed accurately and timely for monthly premiums and/or Late Enrollment Penalties and that any external subsidies (Low Income or SPAP) are applied accurately and timely so members pay only their liability.
• Directs and oversees incoming mailroom activities including the scanning, sorting and routing of incoming mail to the appropriate business units.
• Be the point of contact for regulatory requirements to include Medicare Program Audits, One Third Financial Audits, Quarterly CMS Attestations and implementation of new or revised guidance.
• Ensure organizational policies are developed and maintained within Clover and the BPaas organization and ensure accountability.
• Work cross functionally in support of ensuring applicants and members have the best experience possible.
• Problem solve complex issues and drive to resolution.
• Develop relationships, own communications, and manage day-to-day interactions with BPaas.
• Guide routine calls with BPaas and maximize team efficiency by gathering all updates prior to calls and meetings.
• Ensure BPaas and plan are aligned in terms of expectations, performance and release/delivery timeframes.
• Partner with leadership and team members to develop audit and oversight plans.
• Hold BPaas and/or internal resources accountable to deadlines, deliverables and remediation plans. Raise concerns or issues to leadership.
• Research and address issues with BPaas. Track and trend incidents, change requests and other tickets across multiple platforms.
• Review processes and provide recommendations for improvement or remediation of issues.
• Review vendor performance in comparison with SLAs and CMS requirements. Develop and maintain vendor performance scorecards.
• Develop and track work plans and assist in establishing operational objectives. Identify appropriate resources to support specific tasks and ensure resources are engaged and performing.
• Perform other tasks as assigned.

You should get in touch if:

• You have 3+ years of vendor/BPaas management and oversight experience.
• You have 5+ years of Medicare mailroom or enrollment and billing experience.
• You are a strong communicator with proven experience developing and maintaining professional relationships.
• You can effectively multitask and are able to decipher reports/dashboards and produce presentations and diagrams.